Preliminary Study on Open Labelled Randomized Controlled Trial of the Safety and Efficacy of Hydroxychloroquine and Chloroquine Phosphate for the Treatment of Persons Infected with 2019 Coronavirus Disease in Nigeria

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a causative agent of COVID-19 is a leading cause of ill-health and deaths worldwide. Currently, COVID-19 has no known widely approved therapeutics. Thus, the need for effective treatment.

OBJECTIVES

We investigated the safety and efficacy of two (2) therapeutic agents; chloroquine phosphate (CQ), 2- hydroxychloroquine (HCQ) and a control (standard supportive therapy) among hospitalized adults with COVID-19.

METHODS

The clinical trial was done in accordance to the World Health Organization master protocol for investigational therapeutics for COVID-19. Atotal of 40 participants with laboratory-confirmed positive COVID-19 were enrolled. Blood samples and oropharyngeal (OP) swabs were obtained on days 1,3,15 and 29 for safety and efficacy assessments.

RESULTS

The baseline demographics showed that the median ages in years (range) were 45 (31-57) in CQ, 45 (36.5-60.5) in HCQ, 43 (39.5-67.0) and 44.5 (25.3-51.3) in the control (P<0.042).At randomization, seven (7) participants were asymptomatic, thirty-three (33) had mild symptoms, eight (8) had moderate symptoms while three (3) had severe symptoms. The average day of conversion to negative COVID-19 was 15.5 days for CQ, 16 days for HCQ and 18 days for the control(P=0.036).

CONCLUSION

The safety assessment revealed no adverse effect of the drugs in COVID-19 patients after treatment. These findings proved that chloroquine and hydroxychloroquine are effective for the treatment of COVID-19 among hospitalized adults. It also confirmed that they are safe.

Intimate Partner Violence and Risk Factors among Women during the COVID-19 Movement Restriction in Nigeria: An Online Survey

BACKGROUND

The rapid spread of the SARS-CoV-2 infection in the absence of treatment or the presence of vaccines is forcing nations to respond with strong preventive measures ranging from mitigation, containment, and in extreme cases, quarantines. While these measures are a useful measure of infection control, they can lead to significant social, economic, and psychological consequences. This study sought to establish the prevalence and risk factors of intimate partner violence during the COVID-19 movement restriction in Nigeria among girls and women.

METHODS

An online-based questionnaire survey using Google Forms was conducted over four weeks among girls and women aged 15 years and above. Data analysis was performed using SPSS version 20, and logistic regression was used to determine risk factors for IPV experience during the lockdown.

RESULTS

Overall, 32.8% of respondents reported ever experiencing IPV, and 42.5% experienced IPV during the lockdown. Verbal (35.1%) and psychological (24.1%) violence were the commonest forms of violence in the study. There was considerable overlap between the various forms of IPV in the study. Age less than 35 years (aOR = 1.3; CI = 1.2 - 1.4), resident in the northeast region (aOR=1.6; CI=1.41.9), alcohol (aOR=1.3;CI=1.2-1.5) and substance (aOR = 1.5; CI = 1.3 - 1.8) use, average family monthly income < $100 (aOR = 1.4;CI=1.2 - 1.5), daily or weekly income (aOR = 2.7; CI = 2.5-3.1) had an increased association with IPV during the lockdown, residency in the southeast region had lower odds of experiencing IPV (aOR=.0.5; CI = 0.3-0.8).

CONCLUSION

The reported lockdown prevalence of IPV was 42.8%, with verbal and psychological violence being the most prevalent form of IPV. Age less than 35 years, resident in northeast and southeast, use of alcohol or substances, average family monthly income < $100, and partner being a daily-weekly earner was associated with IPV experience. Policymakers in the future should consider the consequences, including IPV, before issuing such an order.

Challenges of Accessing Care in Art Clinic during COVID-19 Lockdown in Lagos

Background

As the SARS-CoV-2 pandemic continues to ravage the world, its impact on the health systems and survival of people with chronic diseases especially People living with HIV [PLWH] could be undermined. It becomes relevant to assess the challenges PLWH face during this period to institute measures towards combating the negative effects of the pandemic.

Aims

This study aims to investigate the challenges faced by PLWH in accessing care during the lockdown period in Lagos, Nigeria. The study was a cross-sectional one involving PLWH aged 18 years and above who presented for care. An interviewer-administered questionnaire was used to obtain information on demographic characteristics, their knowledge about COVID-19 disease, and challenges experienced in accessing care during the COVID-19-induced lockdown. Ethical approval was obtained from the Institution Research Ethics Board (IRB) of NIMR.

Patients and Methods

Data generated from the survey was exported to Excel and analyzed using SPSS version 23.0.

Results

The mean age of PLWH who participated in the study was 42.2 (±12.2) years. The majority were female (74.3%), married (66.3%), employed (58.9%), and on less than $100 monthly income (80.5%). The commonest challenges experienced were psychological (78.5%), financial (68%) and food (40.7%). There were significant association among the income status, lack of food (OR: 2.5, CI: 1.4-4.5, P = 0.002), financial challenges (OR: 1.7, CI: 1.0-3.0, P = 0.048) and psychological challenges (OR; 1.8, CI: 1.0-3.5, P = 0.05). Ninety-five percent of participants believed SARS-COV-2 infection is a viral infection.

Conclusions

PLWH faces a myriad of challenges that would have a significant impact on their overall well-being and the gains of HIV care.

Prevalence and Clinical Characteristics of Coronavirus Disease 2019 Seen at a Testing Centre in Lagos Nigeria

BACKGROUND

The SARS-CoV-2 infection continues to ravage the global community since it was declared a pandemic. The socio-demographic and clinical characteristics defining the disease are mainly from Europe and Asia. The disease symptomatology is similar to the prevalent diseases in our environment, this could result in the delay in prompt identification and appropriate management of suspected cases toward combating community transmission. This study evaluates the prevalence, socio-demographic and clinical characteristics of positive cases of COVID -19.

METHODS

This was a retrospective cohort study. Data on the socio-demographic, clinical characteristics and the results of the SARS-CoV-2 test of participants at the Nigerian Institute of Medical Research [NIMR] Modified Drive-through Centre for COVID-19 test sample collection over two months [24th February 2020- 27th April 2020] were retrieved from the electronic medical records (EMR). Data obtained were analyzed using SPSS version 22.0.

RESULTS

A total number of 481 clients were evaluated in this review. The prevalence of SARS-CoV-2 infection in the population was 14.6%. The mean age of the positive cases was 42.2 [±15.9] years. The common symptoms reported by the positive cases were fever (40.0%), cough (32.9%), sore throat (17.1%) and running nose (15.7%). Fever depicted statistical significance with positive cases with the majority being of mild to moderate clinical severity.

CONCLUSION

The prevalence of SARS-CoV-2 infection among this cohort was 14.6% with a male preponderance. Fever and sore throat were the variables that predicted SARS CoV-2 infection among our cohort.

Pregnancy, obstetric and neonatal outcomes in HIV positive Nigerian women

While the effect of HIV infection on some maternal outcomes is well established, for some others there is conflicting information on possible association with HIV. In this study we investigated pregnancy and neonatal outcome of HIV positive women in large HIV treatment centre over a period of 84 months. They were managed according to the Nigerian PMTCT protocol. Adverse obstetric and neonatal outcome were observed in 48.3% HIV positives compared 30.3% to the negatives (OR: 2.08; CI: 1.84-2.34). Low birth weight ( OR:2.95; CI:1.95-3.1), preterm delivery (OR:2.05; CI:1.3-3.1), perinatal death (OR:1.9;CI:1.3-3.2), and spontaneous abortion (OR:1.37; CI:1.1-2.3) were factors found to be independently associated with HIV. Low CD4 count (OR: 2.45; CI: 1.34- 4.56) and opportunistic infections (OR: 2.11; CI: 1.56-3.45) were to be associated with adverse obstetric and neonatal outcome. This study confirms the association of HIV, severe immunosuppression and opportunistic infection and adverse obstetric and neonatal outcome.

The burden of anaemia and associated factors in HIV positive Nigerian women

BACKGROUND

Anaemia is the most common complication of pregnancy and a predictor of poor maternal and foetal outcomes. HIV infection is now recognized as one of the major contributors to anaemia in pregnancy. It is therefore important to determine the burden and risk factors of anaemia in maternal HIV infection in others to plan effective prevention strategies as well as optimize management outcomes.

OBJECTIVE

To determine the prevalence and risk factors of anaemia in pregnant HIV positive Nigerians.

METHODS

The prevalence and possible risk factors of anaemia were investigated in HIV positive pregnant Nigerian women at a large HIV treatment clinic in southwestern Nigeria using a cross-sectional design between January 2006 and December 2011.

RESULTS

Nine hundred and eighty-five (42.5 %) women of 2,318 HIV positive pregnant women seen during the period were anaemic by WHO standard defined by haemoglobin <11 g/dl. Majority were of mild to moderate severity (97.9 %). Short inter birth interval (p = 0.002), presence of opportunistic infections (OIs), (p = 0.001), use of zidovudine containing regimen (p = 0.0005) and CD4 cell count <200 cells/mm(3) (p = 0.001) were found to be independently associated with anaemia in HIV positive pregnant women after controlling for confounding variables.

CONCLUSION

Anaemia was found to be high at 42.5 % among the HIV positive women studied and was found to be independently associated with short inter birth interval, presence of OIs, advanced HIV disease and use of zidovudine containing HAART regimen.

Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome

BACKGROUND

Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Its removal is commonly associated with complications. To prevent or control the occurrence of this complication requires the understanding of the factors associated with the complications.

OBJECTIVE

To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in southwestern Nigeria.

METHODS

Study was carried out at two large tertiary hospitals in the south west region of Nigeria. Retrospective review of case records of all surgically managed cases of uterine leiomyoma over a period of 25 years. One hundred and fifty nine women with uterine leiomyoma seen and managed surgically in South-Western Nigeria were the participants.

RESULTS

The common presenting complaints were menstrual irregularities (47.7%), abdominal swelling (39.1%) and infertility (31.9%). The average uterine size at presentation was 15±9.7 weeks. The majority (79.9%) of the women presented with multiple leiomyomata. The commonest anatomical position of the nodules were multiple positions and intramural in 707(60.9%) and 172(14.8%) respectively. Myomectomy was performed in 54.7% of cases. Postoperative complications occurred in 20.9 % of cases with postoperative pyrexia (13.5%), blood loss warranting transfusion (12.8%) and postoperative anaemia (10.4%) been the most common complications.

CONCLUSION

Uterine fibroid is common in our environment and its removal is commonly associated with post-operative pyrexia, blood loss, and anaemia and wound infection. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review.

Effect of oxytocics on the blood pressure of normotensive Nigerian parturients

BACKGROUND

The single most common direct obstetric disorder accounting for 25% of all maternal deaths globally is severe hemorrhage, generally occurring postpartum. Nearly all these deaths occur in the developing world. The role of oxytocic drugs in the management of the third stage of labor as a strategy to reduce maternal mortality has been emphasized. However, the adverse effects of these oxytocic agents, in particular ergometrine, have not been properly evaluated in our environment.

OBJECTIVES

To evaluate the effect of ergometrine and oxytocin on the cardiovascular system when used for active management of the third stage of labor.

STUDY DESIGN

A double-blind, randomized controlled study was carried out at the Federal Medical Centre, Makurdi over 24 months. Five hundred and ten patients were randomized to treatment with either 0.5 mg of intramuscular ergometrine or 10 IU of intravenous oxytocin, respectively, as single injections. Their effects on the cardiovascular system were observed using blood pressure as a marker.

RESULTS

Ergometrine unlike oxytocin was observed to cause a significant rise in blood pressure, and this effect was most marked in the first 24 hours of the puerperium.

CONCLUSIONS

These results suggest that ergometrine may be safe in normotensive parturients but hazardous in hypertensive parturients in whom oxytocin would be a safer option.

Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review

Postpartum haemorrhage is a major cause of maternal morbidity and mortality and occasionally severe enough to warrant hysterectomy to prevent maternal death. Hysterectomy often is fraught with danger and regular audit is necessary to assist in the reduction of these dangers. A 20-year audit of all emergency peripartum hysterectomies, performed at Havana Specialist hospital Lagos, Nigeria, is reported. Of the 6599 deliveries and peripartum referrals seen during the period, 22 had an emergency hysterectomy as a result of severe postpartum haemorrhage (0.33%). The aetiological factors associated with the postpartum haemorrhage included uterine atony (45.5%), placenta praevia (27.3%), pathologically adherent placenta (18.2%) and ruptured uterus (9.1%). The majority of the procedures were subtotal hysterectomy (81.8%) and the mean operative time was significantly shorter than for total hysterectomy (P<0.05). The postoperative complications included postoperative anaemia (28.6%), febrile morbidity (36.9%), wound infection (19.0%) and urinary tract infection (9.5%), together with three maternal deaths. In conclusion, emergency peripartum hysterectomy, although life-saving, is associated with severe morbidity and mortality and subtotal hysterectomy is usually the operation of choice.

Poor obstetric performance of teenagers: is it age- or quality of care-related?

We studied prospectively the effect of antenatal care on the obstetric performance of teenagers seen at a university teaching hospital over a 14-month period. When the obstetric complications among the teenagers were compared to their older counterpart, there were significantly higher complication rates, especially anaemia, preterm delivery, low birth weight and neonatal admission. After controlling for utilisation of antenatal care, significant differences were observed only in the incidence of low birth weight babies. In conclusion, this study has shown that the poor obstetric outcome of teenage pregnancy is related to non-utilisation of prenatal care rather than their biological age.

Delivery outside hospital after antenatal care: prevalence and its predictors

Over a period of 5 years (1994 - 1998), of 9519 women who booked for antenatal care at the two tertiary hospitals of the Obafemi Awolowo University Teaching Hospital Complex, Ile Ife,-Nigeria,12.8% (1220) defaulted from hospital delivery. The casenotes of these patients were retrieved from the medical records department and were sorted into two groups of defaulters and non-defaulters from hospital delivery. Information obtained from the casenotes includes sociodemographic characteristic, past obstetric and present obstetric history. Bivariate analysis revealed six potential predictors; however, following adjustment by multiple logistic regression, only history of previous delivery outside the hospital (OR = 3.13, CI = 2.06 - 4.67), planned elective caesarean section in current pregnancy (OR = 2.03, 1.66 - 2.75), caesarean section in last delivery (OR = 1.93, CI = 1.57 - 2.76) and objection to admission in the current pregnancy (OR = 1.33, CI = 1.04 - 1.65) remained as significant predictors.

Vaginal misoprostol induction of labour: a Nigerian hospital experience

We reviewed our experience with vaginal misoprostol induction of labour in 339 consecutive women with a live fetus and intact fetal membrane using 100 mcg 12-hourly until labour was established. The labours were monitored using the WHO partograph protocol. Two hundred and sixty-five women had a successful induction while 74 had an emergency caesarean section because of cephalopelvic disproportion (63.5%), fetal distress (14.9%), prolonged labour (12.2%), antepartum haemorrhage (6.8%) and other indications (2.8%). The induction delivery interval among the women who had successful induction ranged from 3 hours 42 minutes to 26 hours 15 minutes with a mean of 9 hours 23 minutes (SD 2 hours 41 minutes). Most (73.6%) of these patients delivered within 12 hours of starting induction, the majority (95.3%) requiring only 100 mcg to go into established labour. Complications recorded in this series include fetal distress in 32 (9.4%), postpartum haemorrhage in 23 (6.8%), hyperstimulation in six (1.8%), uterine rupture in one (0.3%), birth asphyxia in eight (2.5%), admission in neonatal intensive care ward in five (1.5%), neonatal death in one (0.3%) and maternal death in one (0.3%) patient. In conclusion, misoprostol was found not only to be efficacious but relatively safe in comparison to other methods of induction in use in our hospital.

Prevalence and pattern of domestic violence against pregnant Nigerian women

Five hundred and twenty-two pregnant Nigerians attending the antenatal clinic in two private hospitals in Lagos between January and June 2003 were interviewed using a structured questionnaire about their experiences of domestic violence. One hundred and four women declined to participate; a response rate of 80.1% was obtained. Analysis of the completed questionnaire by 418 respondents showed that 197 (47.1%) women reported a history of abuse. Of the 197 women who reported abuse, 23 (11.7%) experienced abuse for the first time during the current pregnancy, 97 (49.2%) experienced abuse prior to and during the current pregnancy and in the remaining 77 (39.1%) abuse predate the current pregnancy. A total of 120 (28.7%) women experienced some form of abuse during current pregnancy. Although all social and ethnic groups were involved, no association could be established between prevalence and pattern of abuse and sociodemographic characteristics. Verbal abuse was the most common type of abuse reported (52.3%), followed by economic deprivation (30%), physical abuse (25%), threat of violence (10.8%) and forced sex in 14.2%. The perpetrators of the abuse were husband and boyfriend (78.7%), in-laws (31.5%) and other relations (6.1%). The majority of abused women (99.0%) were not ready to report the abuse to the police. In conclusion, domestic violence is common in our environment and health-care providers should be alert to the clues in order to protect the women from further abuse.

Retained second twin: experience from Ile-Ife, Nigeria

BACKGROUND

Retained second twin contributes significantly to perinatal morbidity and mortality, as well as maternal morbidity and mortality, usually arising as a result of intervention to salvage the retained foetus.

OBJECTIVE

To review the current incidence, management, fate and outcome of both the retained foetus and its mother, with a view to proffering solution.

DESIGN

Retrospective review over a 12 year period from January 1988 to December 1999.

SETTING

Obafemi Awolowo University teaching hospital, Ile Ife, Nigeria.

SUBJECTS

All cases of retained second twin managed during this period.

MAIN OUTCOME MEASURES

Causes, sources of referral, perinatal and maternal complications.

RESULTS

The incidence is still high (7.9%). Majority of the patients were referred from rural centers (49.6%) and in poor fetal conditions (41.9%). The fetal survival in patients that presented within two hours of delivery of the first twin was 74.2%. The perinatal and maternal mortality were 47.3% and 3.9% respectively.

CONCLUSION

The incidence and associated maternal and fetal complications of retained twin is still rather high. Therefore, irrespective of the antenatal course and early labour findings, the conduct of twin deliveries must be in a well-equipped health institution with adequate staff. There should also be an efficient referral system for occasional emergencies from the peripheral centres.

Uterine incision closure at caesarean section: a randomised comparative study of intraperitoneal closure and closure after temporary exteriorisation

BACKGROUND

The safety of the technique of uterine exteriorization at caesarean section though popular among obstetricians, remains controversial.

OBJECTIVE

To evaluate the influence of exteriorization of uterus during uterine repair on caesarean morbidity.

METHODS

A randomized comparative study of 136 women undergoing primary caesarean delivery at Havana Specialist Hospital Lagos Nigeria. Data on operation time, estimated blood loss, postoperative morbidities were collected and analysed with comparison between the two groups using chi square, Fischer's exact test and t-test as appropriate.

RESULTS

The mean operative time, estimated blood loss, transfusion rate and postoperative anemia rate were significantly less in the exteriorized group than the intraperitoneal group (p = 0.000, 0.009,0.048 0.038 and 0.028 respectively), but not in other outcome measures.

CONCLUSION

With shorter operative time, less blood loss and similar morbidity profile exteriorization of uterus during caesarean section seems to be preferred except where it is not possible because of adhesions and surgeons inexperience.

Attitude of rural Nigerian pregnant women to antenatal HIV screening

OBJECTIVE

To assess the knowledge and attitude of rural Nigerian women to the incorporation of HIV screening as part of the routine antenatal screening test at booking.

METHODS

1 820 women were interviewed using a close ended questionnaire at the antenatal clinic of the Federal Medical Centre (FMC) Owo, Nigeria over a period of 12 months.

RESULTS

Though the majority of the women were of low socio-economic status (85.9%) with 20% having less than six years of formal education, 98.6% of them were aware and knowledgeable (89.1%) about HIV/AIDS. The majority (89.9%) of the women accept routine HIV screening as part of antenatal screening.

CONCLUSION

Based on the above findings, obstericians practicing in this locality are encouraged to incorporate HIV screening into their antenatal care.

Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities

This study examines the socioeconomic barriers to safe motherhood in booked patients in the Ife-Ijesha health administrative zone, Nigeria. During the period of study (January 1998 to December 1998), 161 booked patients of Ife State Hospital, Ile-Ife and Wesley Guild Hospital, Ilesha presented with an avoidable obstetric emergency, Seventeen (10.6%) presented during the antenatal period, while 89 (55.3%) and 55 (34.2%) presented in labour and postpartum respectively. The patients presented with obstetric complications such as obstructed labour (24.2%), postpartum haemorrhage (21.1%), puerperal sepsis (24.2%), imminent eclampsia and eclampsia (15.5%), retained second twin (9.3%). Three maternal deaths occurred (MMR 1467/100 000 births) and the perinatal mortality rate was 290/1000 total births. The adduced reasons for late presentation included, financial constrains (85.1%), poor access to hospital/transportation difficulties (33.5%), objection to hospital admission by relatives (23.0%), aversion to caesarean section (21.7%) and attitude to hospital staff (8.1%). The patients were of the opinion that reducing the economic burden associated with hospital fee, provision of transportation, encouraged family support and reduction of operation rate would lead to reduction in late presentation.

Decision-caesarean delivery interval in a Nigerian university hospital: implications for maternal morbidity and mortality

This is a 5-month prospective study to determine the decision emergency caesarean delivery interval in a Nigerian tertiary hospital, the factors responsible for the delays and the consequent maternal and perinatal complications. One hundred and thirty-four emergency caesarean deliveries were analysed and the main indications were failure to progress/ prolonged labour (35.4%), previous caesarean-section/failed trial of scar (27.9%), cephalopelvic disproportion (26.8%), fetal distress (19.5%), pre-eclampsia/eclampsia (15.3%) and obstructed labour/ruptured uterus (14.7%). The mean decision-caesarean delivery interval was 4.4 +/- 4.2 (SD) hours (range 0.5-26 hours), median 3.2 hours and mode 2 hours. Bottlenecks within the maternity unit were responsible for delays in 31.7% of cases. Unavailability of paediatrician (19.6%), non-availability of anaesthetic coverage (13.6%), unreadiness of the operation theatre (11.9%) and seeking second opinion (6.4%) were other major causes of delay. There were 15 perinatal deaths, five of whom were directly linked to the delays i.e. a perinatal mortality rate of 3.7%. Four maternal deaths were directly attributable to delay, a maternal mortality rate of 3%. Other direct consequences of the delays were severe haemorrhage (10.3%), uterine rupture (2.3%) and disseminated intravascular coagulopathy (1.5%). Suggestions on how to minimise delays in emergency services and overall improvement in quality assurance control are discussed.

Ruptured uterus in South Western Nigeria: a reappraisal

INTRODUCTION

Rupture of the gravid uterus is a grave obstetric complication that is associated with high maternal and perinatal mortality rates. In Nigeria, the incidence remains high and continue to increase because of poverty, illiteracy, unavailability of manpower, poor supply of medical equipment and consumables, and dwindling health care funding.

METHODS

A 10-year retrospective review of all cases of ruptured uterus seen at the Obafemi Awolowo University teaching hospital complex in Ile Ife, Nigeria was conducted.

RESULTS

A total of 61 cases of ruptured uterus from 16,683 deliveries were recorded, giving a ratio of 1 in 273. Predisposing or aetiological factors for rupture were: prolonged labour (91.8 percent), grand multiparity (50.8 percent), injudicious use of oxytocin (41.0 percent), uterine scar (26.2 percent), obstetric manipulation (4.9 percent) and abnormal lie (14.8 percent). Fifty-six patients had surgery, of which 14 (25.0 percent) had total abdominal hysterectomy, 16 (28.6 percent) had subtotal hysterectomy, 15 (26.8 percent) had repair of the rupture and bilateral tubal ligation, and 13 (19.6 percent) had repair only. Thirteen maternal deaths occurred with a case fatality rate of 21.3 percent.

CONCLUSION

Ruptured uterus remains a problem in Nigeria, with primary health centres and mission houses being identified as major contributors to this condition. They primarily failed in the recognition of abnormalities in the antepartum and/or intrapartum periods, with delays in referral and the injudicious use of oxytocin.

Risk factors for preterm delivery in south western Nigeria

This was a case-control study to determine the risk factors of preterm delivery among Nigerian women seen at Obafemi Awolowo University teaching hospital, Ile-Ife, Nigeria over a period of 9 months. All women delivering preterm were recruited into the study, with two consecutive term deliveries after each preterm delivery serving as controls. Information obtained from the women includes socio-demographic characteristics, past reproductive and present pregnancy history and outcome. Laboratory investigations were conducted as necessary. Bivariate analysis revealed 21 potential risk factors, however, following adjustment by multiple logistic regression only previous preterm delivery (OR 4.68, 2.24-6.31), previous second trimester spontaneous abortion (OR 4.48, 2.32-8.54), heavy and stressful occupation (OR 3.56, 1.05-6.45), premature rupture of fetal membrane (OR 3.46, 1.04-6.45), maternal medical disorders (OR 3.13, 1.56-5.16), body mass index at delivery of less than 23 (OR 3.01, 1.56-5.43), antepartum haemorrhage (OR 2.73, 1.18-6.34), maternal febrile illness (OR 2.84, 1.32-4.52), intrauterine growth retardation (OR 2.14, 0.98-2.34) and multiple pregnancy (OR 1.98, 1.02-2.68) remained as significant factors.

Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods

Obstructed labour is a common obstetric complication in Nigeria associated with poor fetal and maternal outcome. Delivery of the fetus at caesarean section is always difficult, especially if the fetal head is impacted in the pelvis. The mode of delivery at caesarean section may occasionally compound the morbidity associated with obstructed labour. The purpose of this study was to examine and compare the morbidity and mortality associated with two methods of delivery of the impacted fetal head at caesarean section for obstructed labour (the push method and the pull (reverse breech) method). This study is a prospective study of cases of obstructed labour admitted into the labour ward of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between 1 June 1998 and May 31 2000. One hundred and eight women with obstructed labour at term with live fetus undergoing caesarean section were assigned randomly to either of the methods of admission. The maternal and fetal outcomes were analysed and compared between groups. Patients in the push group had statistically significant higher rates of maternal morbidity (longer operation time, more blood loss, extension of uterine incision, endometritis, longer hospital stay and higher hospital bills) than the pull method (P < 0.05). Also the fetal morbidity was worse in the push group. The 'pull' method of delivery of impacted fetal head at caesarean section for obstruction is safer and faster than the 'push' method.

Emergency obstetric admissions: late referrals, misdiagnoses and consequences

This is a prospective study that examined the nature of emergency obstetric admissions in a Nigerian university hospital in association with such factors as late referrals and misdiagnoses and their contribution to maternal and perinatal morbidity/mortality. The study comprised 144 consecutive emergency obstetric admissions to the hospital over a 6.5-month period. An incidence of 13.6% emergency admissions was recorded. Despite the proximity of the hospital to the parturients, most of them laboured in substandard facilities within the community. Referrals to the university hospital were made only after prolonged delay and onset of complications. Obstetric haemorrhage (24.6%) was the most common cause for referral followed by labour disorders (19%) and hypertensive disorders (8.4%). Thirteen maternal deaths occurred, giving a maternal mortality ratio of 6.2%, while perinatal mortality rate was 461 per 1000 births. Twelve of the maternal deaths were in women living within 5 km of the hospital. There was a caesarean section rate of 50.9%, a 4.8% incidence of diagnostic laparotomy, a 9% incidence of emergency hysterectomy and 44% of emergency blood transfusions. Misdiagnoses of clinical conditions were made by the referring centres in 68% of cases, which contributed to the high maternal morbidity and mortality. Patient attitude was the main cause of non-use of teaching hospital facilities (fear of operation in 32% of cases, dissuasive advice from friends in 27.4% and negative staff attitude in 7%). A need for and type of programme that will promote increased utilisation of modern maternal health services in the community are discussed.

Antenatal HIV screening in South West Nigeria: the client's perspective

This study was carried out at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria with the aim of assessing pregnant clients' opinions on the issue of antenatal HIV screening which is at present very controversial in Nigeria. Five hundred and eighty-six clients were interviewed at the antenatal clinic using a close-ended questionnaire. Three hundred and eighty-five (67.8%) of the clients were found to have a good knowledge of HIV infection and were therefore included in the study sample. Of the clients, 75.1% and 61.5% accepted voluntary and mandatory screening, respectively. Respondent's reasons for accepting screening include prevention of transmission of infection to baby, husband and hospital staff, while reasons for objection to antenatal screening included financial implications, stigmatisation, fear of the outcome of the test and the right to choose. Four hundred and seventy-two (80.6%) and 389 (66.4%) patients will continue the pregnancy and not disclose the result if found positive at screening, respectively, while 11 (1.9%) expressed the view that they might contemplate suicide. Based on these findings, obstetricians in this locality are encouraged to modify the scope of antenatal care by gradually incorporating HIV screening as part of standard and screening procedure at booking or at the first visit.

Uncomplicated Caesarean section: is prolonged hospital stay necessary?

BACKGROUND

Caesarean section among the Yoruba of western Nigerian is surrounded by a lot of fears, miseries, aversion, guilt and misconceptions for reasons varying from the desire by women to have a natural vaginal birth, fear of surgery, morbidity and deaths from the operation and prolonged hospital stay.

OBJECTIVE

To examine issues of reduced hospital stay following Caesarean section with a view of making the operation more acceptable and proffering solution to some of the problems faced by women when Caesarean section is indicated.

DESIGN

A prospective case control study.

SETTING

Wesley Guild Hospital, Ilesha, Nigeria from 1st July, 1997 to 30th June, 1998.

SUBJECTS

One hundred consecutive patients who had uncomplicated Caesarean section, randomised into two groups of short (three days) and prolonged (seven to eight days) hospital stay respectively.

MAIN OUTCOME MEASURES

Observations of patients in both groups were made by an independent observer on day seven post-operation and the main outcomes measured included: wound infection rates, ability to maintain erect posture, mood changes, neonatal sepsis rate, immunisation rate of the neonates and average hospital bills.

RESULTS

The findings revealed that wound infection rates of six per cent and ten per cent among the short and prolonged hospitalised patients respectively are not significantly different. Patients with short stay have better erect posture, lower incidence of depressive mood, lower neonatal sepsis rate, lower hospital bill and are more satisfied with early home discharge.

CONCLUSION

Embracing the concept of early home discharge after Caesarean section in uncomplicated cases may remove some of the psychological upsets and economical impediments associated with the operation and make the operation more acceptable.

Umbilical cord prolapse: a clinical study of 60 cases seen at Obafemi Awolowo University Teaching Hospital, Ile-Ife

The incidence of umbilical cord prolapse at Obafemi Awolowo University teaching hospital complex, Ile-Ife over a ten year period was 0.42% (one in 240 deliveries). The incidence was observed to be higher among the unbooked patients (76.7%). Analysis of the 60 cases reveals that multiparity, unengaged presenting part from cephalo-pelvic disproportion, prematurity, prelabour spontaneous rupture of membranes, breech presentation, and multiple pregnancy were the major contributory factors. The perinatal mortality (36.7%) was significantly higher than that of the hospital which was 8% (P < 0.05). The perinatal mortality rate was higher among the unbooked patients (86.4%). Caesarean section gave better results except when the cervix was fully dilated. Early resort to Caesarean section, proper and adequate antenatal care and properly supervised hospital delivery is recommended.

Puerperal sepsis: a preventable post-partum complication

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed. One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1%. Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.

Ovulation Induction, Pregnancy and Delivery in a Patient with Partial Hypopituitarism due to Lymphocystic Hypophysitis: A Case Report

Lymphocystic hypophysitis is an unusual autoimmune disease that causes partial or total hypopituitarism and often associated with chronic anovulation. We report a case of ovulation induction, uneventful pregnancy and vaginal delivery in one of our patient with lymphocystic hypophysitis. Key words: Lymphocystic hypophysitis, chronic anovulation and ovulation induction.   doi:10.3126/njog.v3i1.1440 NJOG 2008 May-June; 3(1): 46 - 48

Caesarean Section and Perinatal Mortality in South Western Nigeria

Aim: Caesarean section carries a substantial hazard to the unborn fetus, especially if done as an emergencyprocedure. In our environment fetal loss following a caesarean delivery is usually attributed to the procedureby patients and relations who do not readily accept caesarean section as a delivery option.Method: A 10 year descriptive study of caesarean section related perinatal mortality in four tertiary hospitalsin South western Nigeria.Results: Nineteen thousand one hundred and seventy nine deliveries were conducted in the hospitalsduring the study period; five thousand one hundred and ninety five (27.1 %) of which were caesareandeliveries. Two hundred and thirty five of the caesarean deliveries were associated with perinatal death (6.9%.). Majority of these deaths were among the unbooked (73.8%), multiparous (69.0 %) patients and emergencycaesarean delivery (83.4%). Prolonged/ obstructed labour (45.4%), preeclampsia/eclampsia (18.8%) andfetal distress (11.5%), were the commonest indication for caesarean deliveries. While majority of the perinataldeath were still born (60.3%), (39.7%) were early neonatal deaths. The common causes of early neonataldeath in these patients were severe birth asphyxia (37.4 %), neonatal sepsis (22.0%) and prematurity (16.4%).Conclusion: The cause of perinatal mortality associated with caesarean delivery in our environment arepreventable with public enlightenment, provision of affordable and accessible prenatal and neonatal care,discipline, behavioural and attitudinal change of health workers, and the political will on the part of policymakers to maternal and child health delivery care more effective.DOI: 10.3126/njog.v4i1.3332Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 46-48

Obstetric performance in elderly Nigerian women: A comparative study

Aims: To study the obstetric outcome in Nigerian women aged 35 years and above while comparing them with younger women matched for parity, socioeconomic class and body mass index. Method: A cohort of 132 pregnant women aged 35 years and above with another 269 pregnant women aged 20-25 years matched for parity, socioeconomic class and body mass index seen at the obstetric unit of a multidisciplinary proprietary hospital in Lagos Nigeria. Results: There were statistically significant difference between the two group in incidence of chronic hypertension (P = 0.02), gestational diabetes (P = 0.05), symptomatic fibroid (P = 0.01), frequent hospitalisation (P = 0.007), caesarean section (P = 0.005), operative vaginal delivery (P = 0.042), Induction of labour (P = 0.024) premature delivery (P = 0.001), low birth weight (P = 0.021) and congenital abnormality but not in Preeclampsia, malpresentation, obstetric haemorrhage, wound infection and multiple pregnancy . Conclusion: This study demonstrated that women at 35 years and above are high-risk group and should be closely supervised during pregnancy. Keywords: Elderly, Nigerians, obstetric performance   doi:10.3126/njog.v2i1.1468 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 9 - 12 May -June 2007